Provider Demographics
NPI:1922599968
Name:STAT PHARMACY LLC
Entity Type:Organization
Organization Name:STAT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-434-2448
Mailing Address - Street 1:2287 ELLSWORTH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4805
Mailing Address - Country:US
Mailing Address - Phone:734-434-2448
Mailing Address - Fax:734-434-2458
Practice Address - Street 1:212 W EDISON RD
Practice Address - Street 2:SUITE A
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8301
Practice Address - Country:US
Practice Address - Phone:574-252-4495
Practice Address - Fax:574-252-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177866OtherPK
IN300021753Medicaid